Implantation site in complete molar pregnancy: a study of immunologically competent cells with monoclonal antibodies

The nature and intensity of inflammatory cellular infiltrate in the implantation sites of 10 complete molar pregnancies were evaluated by immunohistochemical staining of frozen tissue sections with monoclonal antibodies. As compared to the implantation site in normal pregnancy, there was an increase in the number of infiltrating inflammatory cells in the molar implantation site. Most of the inflammatory cells were T cells with predominance of T4+ (Leu-3a+) cells over T8+ cells. Inflammatory cells were not detected in the molar vesicles. The possible implications of these findings in molar pregnancy are discussed.     

Long-term effect of wedge resection on androgen production in a case of polycystic ovarian disease

A 22-year-old woman with polycystic ovarian disease was evaluated to determine the source of excess androgens. Preoperative 17-ketosteroids ranged between 36 and 45 mg. per 24 hours. Plasma testosterone was 0.05 μg per 100 ml., normal for a woman. Plasma androstenedione was 0.64 μg per 100 ml., markedly elevated. Testosterone production rate was 0.87 mg. per 24 hours, elevated for a woman. Androstenedione production rate was 15 mg. per 24 hours, markedly elevated. Wedge resection of both ovaries resulted in a marked decrease in 17-ketosteroids, plasma androstenedione, and production rates of testosterone and androstenedione. These results suggest that ovarian tissue was a source of excess androgen in this patient with polycystic ovarian disease.     

Aortic lymph node metastases in early ovarian cancer

Aortic node biopsies performed in 26 patients with Stage I ovarian cancer revealed 5 with metastases. All were associated with virulent tumors of the undifferentiated anaplastic or embryonal cell type. The 19 per cent incidence of lymphatic metastasis in this area stresses the need for evaluation of the aortic node chain in patients with early delimited ovarian cancer.     

Angiographic control of pelvic bleeding from treated carcinoma of the cervix

Unremitting hemorrhage in two patients who had been treated by radiation for carcinoma of the cervix was managed by angiographic methods. In one patient, bleeding was shown to be from branches of the hypogastric artery and in the second, from branches of the inferior mesenteric artery. Selective embolization of the bleeding arterial branches with surgical gelatin (gelfoam) was followed by control of the acute hemorrhage in both patients.     

Natural history of diethylstilbestrol-associated genital tract lesions: Cervical ectopy and cervicovaginal hood

There was a marked regression of structural abnormalities associated with in utero exposure to diethylstilbestrol (DES) among 173 women observed for up to 5 years. Cervical ectopy, present in 121 women at initial examination, decreased in extent in 91 women (75.2%) and disappeared completely in 38 (31.4%). The cervicovaginal hood (CVH), present initially in 123 women, diminished in 65 patients (52.8%) and disappeared completely in 35 (28.4%). The longer the follow-up period, the greater the extent of resolution of these lesions. Patients with both findings at entry into the study showed parallel diminution of ectopy and CVH. This investigation documents that DES-associated ectopy and CVH are labile lesions which tend to decrease in extent with time and may eventually disappear.     

Ovarian cancer cachexia—Surgical interactions

The woman with advanced ovarian carcinoma presents unusual risks for complications of cancer therapy. The combined effects of mechanical disruption of gastrointestinal function and the metabolic demand of large tumor burden can produce severe nutritional depletion. The additional stress of extensive surgery may exceed the capacity of the host to meet demands for wound healing and control of infection. Isotonic dextrose infusion inhibits the physiologic adaptation of the host to surgical injury and contributes to postoperative morbidity. Fourteen patients with advanced ovarian carcinoma at high risk for postoperative complications received total parenteral nutrition with hypertonic glucose and essential amino acids. Their hospital course compares favorably with that of two other groups receiving isotonic glucose—11 retrospective high-risk controls and 3 concurrent low-risk patients. We conclude that total parenteral nutrition is a safe and cost-effective means of reducing morbidity and mortality after extensive surgery for selected, high-risk patients with Stage III or IV ovarian carcinoma.     

Correlation of quantitative amniotic fluid cultures with endometritis after cesarean section

At the time of cesarean section, amniotic fluid was collected transabdominally from 60 patients, and quantitative cultures were performed on the amniotic fluid. A culture was defined as positive if ≥10² colony-forming units per milliliter of a high-virulence organism were isolated. Any other result was defined as negative. In 24 patients with no labor or rupture of the membranes, no positive cultures were found, but there was a 25% incidence of endometritis. Among 36 patients with labor or rupture of the membranes, or both, 13 (36%) had a positive culture. Twelve of the 13 (92%) developed endometritis, whereas nine of the 23 (39%) patients with a negative culture had endometritis (p < 0.002). The usual clinical risk factors for endometritis were not different between the positive and negative culture groups. However, the patients with positive cultures had a significantly shorter time interval from cesarean section to endometritis than did the patients with negative cultures (p < 0.02). There was an excellent correlation between a positive amniotic fluid culture and endometritis after cesarean section.     

KLE: a cell line with defective estrogen receptor derived from undifferentiated endometrial cancer

KLE is a cell line derived from a poorly differentiated endometrial carcinoma that is aneuploid with chromosome numbers ranging from 51 to 66 and 6-8 marker chromosomes demonstrated by G banding. Tumors harvested from five of five nude mice bearing an inoculum for more than a month resemble the original specimen, and electron microscopy shows microvilli, many junctional processes, glycogenation, and a prominent nucleolonema. The cell cytosol contains a specific binder for estradiol, but there is no estrogen receptor in the nucleus and in a study reported elsewhere (Raam et al., Breast Cancer Res. Treat. 2, 277 (1982) ) translocation to the nucleus fails to occur. The enzyme phenotype of this cell is human, non-HeLa.     

Response of amenorrheic patients with normal serum prolactin to chlorpromazine during administration of human menopausal gonadotropin

To study the effects of graded amounts of estrogens on prolactin (PRL) secretion, PRL response to chlorpromazine (CPZ) during administration of human menopausal gonadotropin (hMG) was determined. A control CPZ test was done prior to initiation of hMG therapy and the test was repeated when endogenous estrogen secretion reached the physiologic range (350 to 400 pg. per milliliter) which stimulates luteinizing hormone surge in the normal ovulatory menstrual cycle. Six euprolactinemic women with secondary amenorrhea were studied. Studies showed that there was no significant change in the mean serum prolactin concentrations during control and repeat CPZ testing procedure (5.8 +/- 2 and 10.8 +/- 2 ng. per milliliter, p less than 0.1). The maximal response of PRL to CPZ was significantly higher during hMG-induced high estrogenic state than during control testing (69.9 and 32.3 ng. per milliliter, p less than 0.01). This findings suggests that endogenous estrogen may play a role in the regulation of serum prolactin concentration during the menstrual cycle.     

Bicornuate uterus and partial atresia of the fallopian tube.

Partial atresia of the fallopian tube was discovered in two patients with double uteri of the bicornuate variety. The abnormal tube in each case was ipsilateral to a noncommunicating, nonfunctioning, rudimentary uterine horn. A normal fimbriated end led to a short, patent ampullary portion that ended blindly in the mesosalpinx. Realization of the potential for the coexistence of congenital malformation of the fallopian tubes with various uterine malformations suggests that extreme caution be exercised during adnexal surgery in patients with anomalous development of the müllerian ducts.     

Ovarian hyperstimulation syndrome. Report of a case with notes on pathogenesis and treatment

A case of ovarian hyperstimulation is described. This syndrome infrequently appears as a complication of induction of ovulation with human menopausal and chorionic gonadotropins. The clinical manifestations are weight gain, extreme ovarian enlargement, ascites with pleural effusion, oliguria, and hypotension. Severe cases may become life-threatening due to marked fluid shifts, electrolyte imbalance, intravascular hypovolemia, and hypercoagulability. The pathogenesis of this syndrome is discussed, and suggestions are made about management. Therapy is symptomatic, expectant, and conservative unless surgical intervention becomes necessary in cases of intraperitoneal bleeding due to ovarian rupture. Physicians using gonadotropins for the treatment of infertility should be thoroughly familiar with the physiopathology of this complication.     

Correlation of amniotic fluid optical density at 650 nm and lecithin/sphingomyelin ratios with phosphatidylglycerol

In this study we have attempted to correlate amniotic fluid optical density measurements and lecithin/sphingomyelin (L/S) ratios with the presence of phosphatidylglycerol. An 85% correlation (126 of 148) of all three parameters was noted. When the assumption was made that phosphatidylglycerol is indicative of fetal pulmonary maturity, 93 of 94 fluid samples having an optical density at 650 nm greater than or equal to 0.15 had demonstrable phosphatidylglycerol for a 1% false positive rate. In 53 fluid samples having an optical density at 650 nm less than 0.15, phosphatidylglycerol was present in 11 and absent in 42, a 21% false negative rate. The same analyses with lecithin/sphingomyelin ratios showed a 5% false positive rate and a 31% false negative rate.     

Successful treatment of leptomeningeal relapse of epithelial ovarian cancer

A case of isolated leptomeningeal recurrence of an epithelial ovarian cancer was recently diagnosed and treated successfully with methotrexate placed via an Ommaya reservoir in combination with radiation therapy. A review of the literature revealed no other cases of epithelial ovarian leptomeningeal malignancy similarly treated.     

Deficient lung surfactant apoproteins in amniotic fluid with mature phospholipid profile from diabetic pregnancies

An enzyme-linked immunoassay to quantitate lung surfactant apoproteins (15 to 250 ng/ml) in human amniotic fluid is described. The immunoassay was used to quantify lung surfactant in 72 samples of amniotic fluid, for which lecithin/sphingomyelin (L/S) ratios, lecithin and phosphatidylglycerol concentrations, and foam stability indices were also available. The results obtained with the immunoassay were in general agreement with those of the other methods. Measurement of the apoproteins, however, may be a better predictor of fetal lung immaturity and of respiratory distress syndrome than the L/S ratio and the concentration of lecithin. This conclusion is based on the data obtained in the analyses of samples of amniotic fluid from four diabetic and five nondiabetic pregnancies, the infants of which developed respiratory distress. In all cases, the apoprotein concentration was less than 2.1 micrograms/ml, which indicated fetal lung immaturity. In six of these cases (one diabetic and five nondiabetic pregnancies), lung immaturity was also predicted on the basis of other tests. However, in three other cases of diabetic pregnancy, the L/S ratio and lecithin concentration falsely indicated lung maturity. In addition to its being an effective predictor of fetal lung maturity in diabetic, as well as nondiabetic, pregnancies, the immunoassay is better suited for clinical use because of its high specificity, sensitivity, and ease of performance.